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A 49-year-old man presented with a 15-month history of binocular diplopia and oscillopsia and a 6-month history of headaches, memory loss, anorexia, myalgias, and unintentional 105-pound weight loss without diarrhea. Neuro-ophthalmic assessment revealed episodic bursts of opsoclonus, intermittent jerk nystagmus, saccadic pursuit, and slowed and dysmetric saccades, and he was unable to maintain fixation (video 1). Anti-DPPX antibodies were positive in the CSF. He was treated with IV methylprednisolone, plasmapheresis, and rituximab, and his ocular symptoms resolved several months after treatment. Opsoclonus is an ocular manifestation of anti-DPPX encephalitis, which may also cause nystagmus, skew deviation, and saccadic pursuit due to DPPX expression in the cerebellum.1,2
Footnotes
Republished from Neurology® 2019;92:e2298. doi:10.1212/WNL.0000000000007463
Teaching slides links.lww.com/WNL/A875
- © 2019 American Academy of Neurology
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